Noncompliant claims to wait longer

Centers for Medicare and Medicaid Services

Organizations that transmit electronic Medicare claims that don't adhere to national health transaction standards will have to wait two extra weeks to get paid.

Officials from the Centers for Medicare and Medicaid Services (CMS) said they will delay — by an additional 13 days — reimbursements to electronic filers who don't comply with the Health Insurance Portability and Accountability Act (HIPAA). In essence, noncompliant electronic claims will be treated like paper claims.

"The great majority of electronic claims we are receiving meet the required HIPAA standards, but for those still not in compliance there is going to be a delay in getting their money," said Mark McClellan, CMS administrator, in a prepared statement. "We are hoping this will motivate more filers to get into compliance soon."

About 90 percent of Medicare claims currently comply, he said.

CMS modified its HIPAA contingency plan in February. By law, Medicare must pay compliant electronic claims no earlier than 14 days after the date of receipt. Noncompliant claims cannot be paid earlier than 27 days after the receipt date.

The change became effective July 1, but it will start delaying payments for noncompliant claims beginning July 6.

HIPAA, the comprehensive and controversial federal law enacted in 1996, is designed to strengthen privacy procedures involving patient health and medical information, improve security of networks handing sensitive data, and simplify administrative codes and standards for electronic data exchange, among other things.

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